Leakage amniotic fluid or premature rupture of amniotic fluid (PIV or PIOV in different sources) is the rupture of the membranes and the rupture of amniotic fluid before the onset of regular labor with dilatation of the cervix up to 7 - 8 cm.
Normally, the discharge of amniotic fluid occurs spontaneously in the first stage of labor, when the cervix reaches 7–8 cm dilatation; during the next contraction, the woman notices a copious flow of fluid not associated with urination. After the water breaks, contractions usually intensify and birth process accelerates.
Premature rupture of water can occur at any stage of pregnancy, as there are many factors that provoke this condition.
1. Invasive diagnostic methods (amniocentesis)
Amniocentesis is a diagnostic method that involves puncturing the amniotic sac through the anterior abdominal wall under anesthesia and ultrasound guidance and collecting amniotic fluid for biochemical and chromosomal analysis.
In approximately 1% of cases, this procedure is complicated by termination of pregnancy, you will be warned about this in advance and the final decision is always made by the patient.
2. Untreated colpitis of various etiologies
Inflammation of the genital tract progresses without treatment; bacteria (most often a mixed infection) have an invasive ability and, with the help of their enzymes, dissolve the membranes. The connection between infection and premature rupture of amniotic fluid has been proven by many clinical studies; in about a third of cases, leakage of water is the main cause.
3. Intra-amniotic infection
Intra-amniotic infection acts in the same way (damages the membranes) only from the inside. Infection is introduced into the amniotic sac in different ways, both through the blood and ascending from the genital tract (infection from the vagina penetrates into the amniotic fluid without damaging the amniotic sac and already develops massively inside).
4. Clinically narrow pelvis, abnormal fetal positions (oblique, transverse, pelvic), multiple pregnancy, polyhydramnios
Normally, the fetal head at full term is pressed against the bony ring of the entrance to the pelvis, and thereby divides the amniotic fluid into anterior (in front of the fetal head) and posterior (all others). In these conditions, the head of the fetus/the first fetus of twins/triplets is high and there is a lot of water in the lower pole of the amniotic sac, which mechanically puts pressure on the membranes and the risk of leakage of amniotic fluid increases significantly.
ICI is a shortening of the cervix and expansion of the internal uterine os that does not correspond to the gestational age (premature). The expansion of the internal os of the uterus can lead to prolapse (protrusion) of the fetal bladder outward, which leads to infection and rupture of the membranes.
I. Rupture of membranes(this is an obvious condition, which is accompanied by the rupture of anterior amniotic fluid)
1) Copious painless discharge of light (turbid/greenish/straw-colored, etc.) fluid not associated with urination
2) Decrease in the height of the uterine fundus (the outpouring of water reduces the intrauterine volume and the abdomen becomes smaller in size and denser)
3) The development of labor after the rupture of water (does not always occur; the rupture of amniotic fluid is early stages, as a rule, does not provoke the immediate development of labor)
4) Changes in fetal movements (slowing down movements, as the volume of the uterus has decreased and its tone has increased)
II. High/lateral opening of membranes(this condition may go unnoticed, as it occurs with subtle symptoms and is extended over time)
1) An increase in vaginal discharge, which becomes thinner, waterier, soaks the underwear and does not stop. They also get worse when coughing and lying down (for the majority).
2) Nagging pain in the lower abdomen, bloody issues(not always the case)
3) Change in fetal movements
- termination of pregnancy (most often we are talking about late miscarriage up to 22 weeks)
- premature birth. Premature birth occur between 22 weeks and 36 weeks and 5 days and entail many complications for the mother and fetus, the severity of the condition depends on the duration of pregnancy.
Abnormalities of labor (weakness of labor, discoordination of labor, etc.)
- hypoxia and asphyxia of the fetus (a long anhydrous period and anomalies of labor lead to disruption of the blood supply to the fetus through the umbilical cord and oxygen starvation of the fetus of varying severity develops)
Respiratory distress syndrome in a newborn (the surfactant in the baby’s lungs matures closer to 35 - 36 weeks, earlier rupture of water and childbirth entail inferior lung function)
Infectious and inflammatory complications in a newborn (inflammatory skin diseases, congenital pneumonia)
Intraventricular hemorrhages, cerebral (cerebral) ischemia in a child
Skeletal deformation and self-amputation of limbs in a child during a long anhydrous period (amniotic cords are formed that injure the fetus)
Chorioamnionitis (inflammation of the membranes during a long anhydrous period)
Postpartum endometritis. Endometritis (or metroendometritis) is an inflammation of the internal uterine wall, which most often develops in women with premature rupture of water, and the longer the anhydrous period (without antibiotic prophylaxis), the higher the risk of the disease. If chorioamnionitis develops during childbirth, then postpartum period the likelihood of developing endometritis is extremely high.
Obstetric sepsis. Obstetric sepsis is the most serious infectious and inflammatory complication in the postpartum period with high mortality.
If you notice vague, copious watery discharge, you should urinate, take a shower, wipe yourself dry (dry the perineum thoroughly) and place a clean, dry white pad (a white cotton diaper is best) between your legs, after 15 minutes you should check the pad. Or lie down on a dry sheet without underwear. A wet spot on the sheet or a wet lining indicates possible leakage of amniotic fluid. In this case, you should collect a minimum of things in maternity hospital and call an ambulance (or go to the emergency room of the maternity hospital yourself).
- if you suspect water leakage, but the discharge is not abundant, does not wet the laundry, does not have a special smell or color, then you can do it at home placental microglobulin test(PAMG – 1), at the moment it is produced only under one brand, Amnisure ROM Test (Amnishur).
This is a test - a system intended for independent use; all the necessary items indicated are included in the kit.
How to do a water leak test:
Place a tampon into the vagina to a depth of 5–7 cm for a period of one minute
Immerse the swab in the solvent tube for 1 minute and rinse well with a rotating motion.
Place the test strip in the tube for 15 - 20 seconds
Place the strip on a clean, dry surface and after 5 - 10 minutes you can evaluate the result
One strip – there is no leakage of water, two stripes – there is leakage of amniotic fluid
Test reliability 98.7%
Do not read the result if more than 15 minutes have passed
Test pads for leakage of amniotic fluid (Frautestamnio, Al-sense) are a pad with a reagent-impregnated area (indicator) or liner. The indicator contains a colorimetric indicator that changes yellow in blue – green when in contact with liquids with high pH. Normally, the pH in the vagina is 3.8-4.5, the pH of amniotic fluid is 6.5-7. The test pad changes color when it comes into contact with a liquid that has a pH level greater than 5.5.
The pad should be attached to the underwear as usual, with the yellow indicator facing the vagina. The pad is used for about half an hour, or until sufficiently moistened, it can be used for up to 12 hours, and then the color is assessed and compared with the color scale on the packaging. Blue-green color may indicate leakage of amniotic fluid. The indicator color remains stable for up to 48 hours. If after drying the color turns yellow again, this most likely means that there was a reaction with ammonia in the urine. But only a doctor will give you a final conclusion.
There are also gaskets on sale with a removable indicator liner (Al - Rekah), after using the gasket as described above, the liner is removed by pulling the protruding tip, placed in a bag and wait for the result for about 30 minutes. The color will also change to blue-green.
The gaskets are easy to use and accessible, but their information content is somewhat lower than the test systems.
A false positive result can be caused by:
Colpitis of any etiology
- bacterial vaginosis
- recent sexual intercourse
- douching
In all these cases, the pH of the vaginal secretion changes and a false positive result is possible.
Gynecological examination in speculum with cough test
When examined in the speculum, the cervix is exposed, and the doctor asks the patient to cough; if the amniotic sac ruptures, the amniotic fluid will leak in portions with a cough impulse. Sometimes, when examined in the mirrors, a clear leakage of water is visible, the fluid is in the posterior fornix, then a cough test may not be performed.
The nitrazine test (amniotest) shows the most reliable result within 1 hour after the water breaks. The amniotest is a swab with a cotton tip soaked in a reagent, which must be placed in the posterior vaginal fornix and the color change assessed. However, a false positive result can be caused by the same factors as when using test pads.
Ultrasound (the ultrasound doctor measures the level of amniotic fluid, also known as the amniotic fluid index - AIF, and compares it with the data of the previous ultrasound; after the rupture of water, it decreases sharply).
Oligohydramnios (severe oligohydramnios) in combination with fluid leakage confirmed by gynecological examination confirms the diagnosis of PIV.
Tactics for the expiration of amniotic fluid at different times.
Up to 22 weeks
Prolonging pregnancy is not advisable due to the minimal chance of fetal survival and the frequency of purulent-septic complications on the part of the mother. The patient is subject to hospitalization in the gynecological department, where the pregnancy is terminated for medical reasons.
22–24 weeks
Hospitalization of the patient to the pregnancy pathology department and explanation of the risks and consequences for the mother and fetus.
The prognosis for the fetus at this stage is still extremely unfavorable. Parents are warned that children born at this stage are unlikely to survive, and those that survive will not be healthy (the risk of cerebral palsy, blindness, deafness and other neurological disorders is high). If the patient categorically insists on prolonging pregnancy, despite these risks, antibiotic prophylaxis is carried out as indicated below.
25 – 32 weeks
Up to 34 weeks, in the absence of contraindications, expectant management is indicated, taking into account the duration of pregnancy. Waiting tactics in the period 25 – 32 weeks no more than 11 days.
32 – 34 weeks
Watchful waiting is indicated for no more than 7 days.
34 – 36 weeks
Waiting strategy is indicated for no more than 24 hours.
37 weeks or more
Expectant management is indicated for no more than 12 hours, then the beginning of labor induction is indicated. In this case, antibiotic prophylaxis begins after an 18-hour water-free period.
Chorioamnionitis
- preeclampsia/eclampsia
- premature abruption of a normally located placenta
- bleeding with placenta previa
- decompensated condition of the mother
- decompensated condition of the fetus
If there is a contraindication to expectant management, the method of delivery is chosen on an individual basis.
1. Examination of the cervix in the mirrors, vaginal examination is carried out only upon admission, then it is not carried out
2. During the initial examination in the mirrors - sowing on the flora and sensitivity to antibiotics
When establishing the fact of outflowing waters - the immediate start of antibiotic prophylaxis of purulent - septic complications of the mother and fetus (chorioamnionitis, neonatal sepsis, obstetric sepsis)
Erythromycin peros 0.5 g every 6 hours to 10 days;
Ampicillin peros 0.5 g every 6 hours up to 10 days;
or if beta-hemolytic streptococcus is detected in microbiological crops
Penicillin 1.5 g IM every 4 hours
3. Prophylaxis of respiratory distress syndrome (SDR) with dexamethasone (8 mg IM No. 3 under the supervision of a doctor with control of fetal movements and heartbeat), it should take about two days to obtain the effect. Dexamethasone is a glucocorticoid hormone that accelerates the maturation of surfactant in the baby's lungs. Prevention of SDR is carried out within 24–34 weeks.
4. Thermometry every 4 hours
5. Control of the fetal heart rate, secretions from the genital tract, uterine contractions at least 2 times a day
6. General analysis blood at admission and in the future at least 1 time in 2-3 days;
7. Ultrasound examination 1 time in 7 days with the determination of the amniotic fluid index and Doppler blood flow in the uterine arteries and umbilical artery
8. Cardiotocography with assessment of a non-stress test (reaction of the fetal heartbeat to its own movements) at least 1 time per day
9. If there are uterine contractions with a frequency of more than 3-4 in 10 minutes - tocolysis (introduction medicines, which relieve contractile activity of the uterus, the drug hexoprenaline is most often used; the dose and rate of administration are chosen by the attending physician)
10. If labor develops no less than 48-72 hours after the first injection of dexamethasone, tocolysis is not performed.
After the maximum waiting period has expired, a consultation of doctors is examined to select a method of delivery. Preparation of the cervix and labor induction or caesarean section are possible. Both methods have their advantages and risks, so in each case the issue is resolved strictly individually.
1. For PIV after 32 weeks - immediate induction of labor.
2. For PIV up to 32 weeks, expectant management is indicated, aimed at preventing fetal SDR and chorioamnionitis (antibiotic prophylaxis, as indicated above).
3. Prevention of vertical transmission of the virus.
4. Labor induction is indicated 48 hours after the start of fetal SDR prophylaxis.
5. In case of premature rupture of amniotic fluid, cesarean section does not reduce the risk of transmission of the virus from mother to fetus.
Despite the simplicity and availability of home diagnostic methods, you should not neglect an emergency visit to your doctor if you suspect leakage of amniotic fluid. The earlier the diagnosis is made, the more favorable the result at any stage of pregnancy. We wish you a safe pregnancy and an easy full-term birth. Take care of yourself and be healthy!
Obstetrician-gynecologist Petrova A.V.
First pregnancy - how new life, in which unfamiliar and sometimes unexpected phenomena await a woman. Once you get used to growing body size and weight, changes in mood and taste preferences, new discoveries begin. Some of them are pleasant and encouraging, brightening up the 9 months of waiting for the baby. It’s better to learn about others early, preferably only in theory, without encountering them in practice. For example, about how amniotic fluid leaks and what needs to be done in this case. For most pregnant women, leakage of amniotic fluid is a nightmare with which they scare themselves and each other.
In fact, amniotic fluid does not leak in everyone and not as often as it might seem if you stress yourself out. But every woman should know what to do in case of leakage of amniotic fluid - at least just in case. This will help determine whether amniotic fluid is actually leaking or not. Moreover, leakage is possible not only during the first pregnancy, and the information will be useful to you or your loved ones in the future. As you know, fear has big eyes, but in everything related to pregnancy and health in general, you cannot rely on intuition and fragmentary information. It is necessary to clearly understand how amniotic fluid leaks and what to do in this case.
Amniotic fluid and its leakage
Amniotic fluid is the fluid that surrounds the embryo. Amniotic fluid, or amniotic fluid, surrounds the baby throughout intrauterine development and protects it from all infections, physical and any other dangers. The chemical composition of amniotic fluid is rich in vitamins, salts, hormones, amino acids, and also contains waste products, vellus hairs and particles of fetal skin. This determines the functions and capabilities of amniotic fluid:
How and why do amniotic fluid leak?
Normally, amniotic fluid is released at the end of the first stage of labor, when the cervix opens. Premature rupture, which began long before the onset of labor, and especially at less than 37 weeks, is called leakage of amniotic fluid. The reasons for leakage are different:
Signs of leakage of amniotic fluid. How amniotic fluid leaks
It is important to promptly notice and identify water leakage, but not to confuse it with other natural body secretions, urination, etc. It's not hard to make a mistake, especially with the excitement associated with pregnancy. Therefore, remember how amniotic fluid leaks:
The main thing a pregnant woman needs to do when amniotic fluid leaks is to consult a doctor, in no case waiting for a routine routine examination. If you act quickly and correctly, you will be able to avoid bad consequences. Timely diagnosis and treatment for leakage of amniotic fluid increases the likelihood of normal labor and protection from infections. The safety of amniotic fluid leakage is directly proportional to the duration of pregnancy. The longer the period, the less risk to health and life. In any case, now you know how amniotic fluid leaks and the strategy for dealing with this. And we sincerely wish you not to encounter this problem and give birth to a healthy, beautiful and happy baby!
Often expectant mothers worry that they will miss leakage of amniotic fluid; the symptoms are unknown to them. Often, increased vaginal secretion is mistaken for amniotic fluid, or vice versa - leakage of amniotic fluid is regarded as normal discharge.
Amniotic fluid is the baby’s habitat for 9 months. The reservoir for amniotic fluid is the amniotic sac, which is formed in parallel with the development of the child. Amniotic fluid is formed by sweating components of maternal blood through the vessels of the placenta. The amount of water increases during pregnancy and only before childbirth can its volume decrease. On average, the amount of amniotic fluid at birth is 1.0-1.5 liters. The role of amniotic fluid is difficult to overestimate: they contribute to the normal development of the growing body, protecting the child from compression by the walls of the uterus and from external physical influences. The baby can move freely in the uterine cavity, which contributes to its harmonious development. In addition, the membranes and amniotic fluid are a fairly reliable barrier to the penetration of pathogenic microorganisms from outside.
Normally, rupture of the membranes and rupture of amniotic fluid occurs in the first stage of labor, at least 38 weeks of pregnancy. Usually, recognizing this process is not difficult: enough water is poured out at once. a large number of(about 0.5 liters) of amniotic fluid, they have a slight specific smell, their discharge is accompanied by increasing contractions.
Premature rupture of amniotic fluid occurs, most often, during pregnancy, which occurs with inflammatory processes of the vagina and cervix. Under the influence of microorganisms, the fetal membranes become thinner, lose their elasticity and cannot fully perform their functions.
As a result, leakage of amniotic fluid occurs, the symptoms of which are very difficult to determine independently. Amniotic fluid can be released in drops for a fairly long period of time and not cause any suspicion in the pregnant woman.
Even with gynecological examination It is not always possible to detect leakage of amniotic fluid: the symptoms are very scarce. To obtain a reliable answer, a number of laboratory tests are carried out. The simplest is to conduct a cytological examination of a smear from the posterior fornix of pregnancy. When amniotic fluid leaks, the smear, in addition to the usual vaginal contents, contains elements of amniotic fluid.
In addition, rapid tests for the qualitative determination of amniotic fluid have recently become widespread. Such a test can also be carried out at home, which protects a pregnant woman from unnecessary worries, or allows her not to miss time to see a doctor in a timely manner.
Currently, the approach to premature rupture of amniotic fluid is unambiguous - only delivery in a short time. Attempts to maintain a pregnancy with impaired integrity of the amniotic sac have not justified themselves due to frequent septic complications in mother and child.
Amniotic fluid or amniotic fluid is the natural environment for the life and development of the fetus in the womb.
The main functions of fetal fluid:
Metabolism.
Participation in labor.
The rupture of water after the 37th week of pregnancy (full term) is considered physiological at the onset of labor. Provided that the cervix is dilated and ready for labor.
If water leakage occurs earlier, then this causes concern and is a pathology. At the same time, there is a high risk of infection. But timely preventive measures will help avoid this.
There can be several reasons for water leakage:
Infection.
Some diagnostic tests.
Multiple pregnancy or polyhydramnios.
Some pathologies.
Signs that indicate leakage of amniotic fluid:
Leakage of amniotic fluid can be determined at home. There are special tests for this that can be purchased at any pharmacy.
There are two types of tests:
Their mechanism of action is the same - determining changes in the environment (Ph) in the vagina. When amniotic fluid gets on the test (on a certain area), it turns green-blue. More detailed details are described in the attached instructions.
These tests do not provide a 100% guarantee, since the presence of an infectious process in the vagina can also lead to a change in Ph.
Important! Remember that even if you suspect leakage of amniotic fluid, you must immediately inform your obstetrician-gynecologist, as this carries some risks.
The doctor determines water leakage using a special smear. When amniotic fluid enters the vagina, a certain protein is found in it, which is found only in amniotic fluid.
The method for eliminating the problem depends on the stage of pregnancy at which the leakage occurred. However, it is impossible to completely stop the disorder; the goal of treatment is to maintain the safety of the fetus and mother.
If leakage occurs during advanced pregnancy, this may indicate that labor is imminent. If contractions do not begin after 3 hours, the obstetrician stimulates labor or performs a cesarean section.
In case of a premature pregnancy, the woman is in a hospital with strict bed rest. Antibiotics and treatment of the genital tract with antiseptic drugs are prescribed.
When the membranes rupture, there is a very high risk of infection of the fetus. As soon as water leakage is confirmed, the doctor immediately sends the pregnant woman for an ultrasound. Using this diagnostic method, the degree of full term of the child is determined. If he is ready to breathe on his own and be born, a cesarean section is scheduled to avoid irreversible consequences of infection.
If the fetus is still premature and not ripe, then the pregnant woman is hospitalized urgently. Antibacterial therapy is carried out for the purpose of prevention and strict bed rest is prescribed. As soon as the baby can breathe on his own, delivery will take place.
Some studies during pregnancy
During pregnancy, a woman's body produces so-called amniotic fluid. It surrounds the fetus and performs various functions: metabolism, protection from external influences, maintaining sterility, etc. Its outpouring is usually a sign of the onset of labor. However, it happens that even before the expected birth, water begins to leak. It is then that the question may arise of how to distinguish leakage of amniotic fluid from discharge.
It is not difficult to notice a one-time leak of amniotic fluid. It can be up to 500 ml in volume. This happens when the amniotic sac ruptures at its base near the cervix. In this case, nothing prevents the liquid from immediately coming out. If the rupture occurs in another place, then the amniotic fluid may drain gradually. Their small amount can easily be confused with normal discharge or urinary incontinence, which is sometimes observed in pregnant women.
Water leakage can be recognized by a number of basic signs:
Based on these signs alone, it is sometimes difficult to understand what you have to deal with - heavy discharge or gradually receding water. Therefore, there are several methods for determining.
To correctly diagnose leakage, you can perform a test or contact your gynecologist.
How to determine at home? The gradual outpouring of amniotic fluid, without consulting a doctor, can be detected in two ways:
In any case, only a specialist can confirm or deny leakage of amniotic fluid or discharge, so if you have any suspicions, you should immediately seek help.
The gynecologist will conduct an examination on the chair. During this process, you may be asked to cough to increase intra-abdominal pressure. If the amniotic sac is damaged, a small release of fluid will occur. Additionally, the doctor will take a smear to identify elements characteristic of the substance. Only based on the results of such analyzes you will have a 100% answer.
Normally, the release of amniotic fluid occurs at the initial stage of labor, when the cervix begins to open slightly and the amniotic sac spontaneously ruptures under the stress of contractions. Pregnancy is considered full-term if this process begins at 37 weeks or more.
The reasons for premature effusion may be the following:
Usually, at the beginning of pregnancy, a gynecologist reports the danger of premature rupture of amniotic fluid, especially if you are at high risk of developing this phenomenon.
The effusion may occur in different time. Depending on this characteristic, several varieties are distinguished:
Any of these options can be considered favorable if the pregnancy is full-term and labor begins on time. If this happens before 37 weeks, the doctor will act according to the situation, based on the danger to the fetus and the woman herself.
The consequences of early leakage of amniotic fluid can be judged from the functions that this fluid performs for the baby. For example, it protects the fetus from all types of infections. Violation of the shell can open access to any viruses and strains. Reducing the amount of water may also impair their barrier function against mechanical damage. And, among other things, this substance prevents the child from being compressed by the umbilical cord and ensures normal blood circulation in all his limbs.
Amniotic fluid is a unique environment for a living organism, which is enriched with all the elements necessary for its life. It plays the role of the immune system until birth. Any violation in its composition can lead to harmful consequences. Therefore, early diagnosis of this phenomenon can preserve the pregnancy and the health of the baby to the maximum. And, of course, the gestational age is considered an important factor determining the danger of the phenomenon. The larger it is, the higher the chances of avoiding any negative consequences.
The tactics of doctors in identifying such a problem completely depend on the duration of pregnancy and the level of readiness of the birth canal.
In the first stages, specialists must find out the time when the leakage began. If it is more than six hours, then antibiotic therapy is urgently prescribed to prevent infection of the fetus.
In a full-term pregnancy, labor begins already after 2-3 hours; if this does not happen, labor stimulation is prescribed. In this case, you should find out the readiness of the cervix for childbirth. Her immaturity in this situation also necessitates hormonal therapy.
Contraindications to natural delivery become an indication for caesarean section.
In cases where leakage was detected before 35 weeks, if there are no signs of infection, the woman is monitored in the hospital. This is due to the fact that before this period development occurs respiratory tract child, and every day is very important for him. In this case, the woman is shown:
In itself, the prevention of early leakage of amniotic fluid includes early treatment of isthmic-cervical insufficiency and the threat of miscarriage. In the latter case, the woman is placed for safekeeping in medical institution. In addition, it is necessary to sanitize the birth canal and prevent inflammatory and infectious diseases.
Any uncharacteristic phenomena, be it, must be promptly reported to the gynecologist who is managing your pregnancy. Early diagnosis many diseases and pathologies can increase the chances of a favorable birth.
